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Gli Autori, dopo aver prospettato la legittimità dell'amministratore di sostegno ad esercitare il diritto all'autodeterminazione circa i trattamenti sanitari concernenti il suo assistito, analizzano la possibilità di applicare l'istituto in discorso qualora l'individuo, capace di intendere e di volere al tempo della designazione dell'amministratore di sostegno, sia affetto da una malattia che in un futuro più o meno prossimo lo condurrà inesorabilmente alla perdita di coscienza. Oltre all'assunzione della misura protettiva in argomento, meritevole di essere attentamente considerata è risultata, inoltre, sempre con riferimento a pazienti affetti da una patologia cronica o caratterizzata da inarrestabile evoluzione a prognosi infausta, la possibilità di realizzare, in ossequio all'art. 5 della recente legge del 22 dicembre 2017, n. 219 (rubricata « Norme in materia di consenso informato e di disposizioni anticipate di trattamento »), una « pianificazione delle cure » condivisa tra il paziente e il medico. È stato, infine, affrontato il problema fondamentale relativo alla necessità di elaborare una soluzione che permetta di sottrarre anche le persone sane per l'ipotesi che diventino incapaci al rischio di assoggettamento a terapie inutili ed oltremodo aggressive, essendo loro precluse sia la nomina dell'amministratore di sostegno che la pianificazione condivisa delle cure. Una strada percorribile potrebbe essere quella di redigere delle Disposizioni Anticipate di Trattamento, in conformità all'art. 4 della già citata legge n. 219. Legge, questa, con riferimento alla quale, pur apprezzando l'indefettibile adempimento di cui si è fatto carico il Legislatore consistente nell'assumere piena consapevolezza dei bisogni, delle istanze dei soggetti che ne saranno i destinatari e nell'affermare esplicitamente quanto tra l'altro era già desumibile dall'applicazione dei principi generali in materia, in questa sede, qualche perplessità è stata esposta in merito all'iter genetico della stessa e al modo con cui è stata operata una “conciliazione” tra gli interessi riconducibili al paziente e quelli riferibili al medico.

Aims and objectives. To observe the clinical and structural factors that can be associated with the post-operative onset of delirium in patients who have undergone heart surgery. Background. Several risk factors could contribute to the development of delirium, such as the use of some sedative drugs and a patient’s history with certain types of acute chronic disease. However, in the literature, there is little knowledge about the association between delirium in patients who have undergone cardio-surgical intervention and their clinical and environmental predictors. Design. We used an observational design. Methods. We enrolled 89 hospitalised patients in the ICU. Patients were first evaluated using the Richmond Agitation Sedation Scale (RASS) and subsequently using the Confusion Assessment Method for the ICU (CAM-ICU). A linear model of regression was used to identify the predictors of delirium in patients. Results. The patients had an average age of 89 years (SD=6.9), were predominantly male (84.3%) and were mostly married (79.8%). The majority of patients had been subjected to bypass (80.9%), while 19.1% had undergone the intervention of endo prosthesis. The logistic regression model showed that patient age, the duration of VAM, continuous exposure to artificial light and the presence of sleep disorders were predictors of the onset of delirium. Conclusion. This study further confirms that clinical aspects such as insomnia and one’s circadian rhythm as well as structural elements such as exposure to artificial light are variables that should be monitored in order to prevent and treat the onset of severe post-operative delirium. Relevance to clinical practice. Identifying the possible factors that predispose a patient to the onset of delirium during intensive therapy following cardiac surgery, it is fundamental to implement interventions to prevent this syndrome.

The not uncommon occurrence of Abusive Head Trauma (AHT) together with the difficulties in diagnosis, the risk of recurrence of violent conduct as well as the important neurological sequelae make it appropriate to conduct extensive cognitive studies aimed at identifying the clinical and instrumental criteria useful for the diagnosis of the aforementioned abuse syndrome. Approximately 30-50% of shaken children present, as sequelae of brain trauma, major neurological and cognitive deficits; from 7 to 30% die from the consequences associated with AHT. The diagnosis of AHT is difficult to formulate because frequently there is no external injury and there are no specific symptoms, so a differential diagnosis with other pathological aspects is necessary. The Authors seek to promote a more widespread knowledge of the clinical signs that characterize this syndrome, as well as to establish guidelines to facilitate diagnosis.

In spite of the continuos decrease of incidence in the perinatal and children's mortality the continuos progress of the obstretic sciences and changes in environment, the children cerebral palsy nowdays is still a disease which affects about 2/3 per 1000 of birth. A lot if studies about the reason of the illness are numerous and recent. In this situation the modern knowledges in the genetic and obstetric field have changed the causes, reducing openly the facts before attributed to the birth or the after birth and underlining the hereditary aspect. The affects of such evolution assume a great importance in the cures, and about the professional responsability concerning the medical staff during the period of pregnancy and of the birth and after birth. Principles of valuation aimed to give are objective judgement, are proposed on this last problem. In order to understand the existence medical responsability.

It has been estimated that approximately one in seven of all global suicides is due to pesticide self-poisoning, mostly in rural areas of developing countries. Organophosphorus (OP) compounds are a group of pesticides exerting their toxicological effects through non-reversible inhibition of the enzyme acetylcholinesterase (AChE). Among these compounds, phorate (thimet) is one of the most dangerous compounds, the use of which is restricted in many countries. A case of intentional suicide after phorate ingestion in a 24-year-old Bengali male is described. This is the second case of suicidal ingestion of phorate reported in the forensic literature, and the first presenting complete toxicological findings.

Highlights • SARS-CoV-2 causes acute respiratory distress syndrome (ARDS) and multiple organ failure until death. • Myocarditis, acute myocardial infarction, arrhythmias thromboembolism, and disseminated intravascular coagulation (DIC) are the main complications in patients with cardiovascular comorbidities. • SARSCoV-2 can worsen the clinical status of patients with comorbidities especially pre-existing cardiovascular diseases and this may interfere with therapies., A novel coronavirus SARS-CoV-2 causes acute respiratory distress syndrome (ARDS) with cardiovascular and multiple organ failure till death. The main mechanisms of virus internalization and interaction with the host are down-regulation or upregulation of the ACE2 receptor, the surface glycoprotein competition mechanism for the binding of porphyrin to iron in heme formation as well as interference with the immune system. The interference on renin–angiotensin–aldosterone system (RAAS) activation, heme formation, and the immune response is responsible for infection diffusion, endothelial dysfunction, vasoconstriction, oxidative damage and releasing of inflammatory mediators. The main pathological findings are bilateral interstitial pneumonia with diffuse alveolar damage (DAD). Because ACE receptor is also present in the endothelium of other districts as well as in different cell types, and as porphyrins are transporters in the blood and other biological liquids of iron forming heme, which is important in the assembly of the hemoglobin, myoglobin and the cytochromes, multiorgan damage occurs both primitive and secondary to lung damage. More relevantly, myocarditis, acute myocardial infarction, thromboembolism, and disseminated intravasal coagulation (DIC) are described as complications in patients with poor outcome. Here, we investigated the role of SARSCoV-2 on the cardiovascular system and in patients with cardiovascular comorbidities, and possible drug interference on the heart.

Child maltreatment is a phenomenon of great importance due to the significant socio-health implications related to it. Purpose of the study is assessing compliance child abuse clinical management with guidelines and suggest corrective actions to avoid false negative or false positive judgments. The data come from 34 medical records of child victims of suspected abuse hospitalized in a pediatric clinic. We examined diagnostic and medico-legal management through the analysis of pediatric, dermatological, ophthalmological (including fundus examination), and gynecological (only in some cases) consultations, brain and skeletal imaging, laboratory tests (with reference to the study of hemostasis), and medico-legal advice. Of 34 patients, the average age was 23 months, ranging from 1 month to 8 years. The judgment was positive for abuse for 20 patients and negative for 12 patients; in two cases it was not possible to express a conclusive judgment. Two children died because of the injuries sustained. We underline the need of clinical-diagnostic standardized protocols, coroner in emergency settings, short-distance follow-up, social worker support. We also suggest objectifying in a descriptive way (using a common and repeatable language) and with photographic documentation the results of all the investigations carried out, to evaluate signs of physical maltreatment and neglect.

Objectives: To evaluate autoptic histopathological findings of arrhythmogenic ventricular cardiomyopathy (AVC) as major cause of sudden cardiac death (SCD) in young adults. Background: According to Heart Rhythm Society (HRS)’s international consensus, histological criteria for AVC diagnosis include a progressive myocardial atrophy of the right ventricle characterized by a transmural fatty or fibrofatty replacement in a segmental or diffuse pattern (residual myocytes

Il contributo indaga il rapporto tra città sumeriche e divinità poliadi nella Mesopotamia del III millennio a.C.

Cerebral tissues in human remains are rare archaeological discoveries. These tissues are typically saponified, meaning that their triglycerides have been converted to glycerol and fatty acid salts, or soap. In c.e. 79, a volcanic hot ash avalanche rapidly killed the inhabitants of Pompeii and Herculaneum. In the 1960s, at the Collegium Augustalium in Herculaneum, a human victim of the avalanche was found lying on a wooden bed, buried by volcanic ash. In this victim’s skull, we discovered apparent brain remains that were vitrified instead of saponified.

Detecting the ultrastructure of brain tissue in human archaeological remains is a rare event that can offer unique insights into the structure of the ancient central nervous system (CNS). Yet ancient brains reported in the literature show only poor preservation of neuronal structures. Using scanning electron microscopy (SEM) and advanced image processing tools, we describe the direct visualization of neuronal tissue in vitrified brain and spinal cord remains which we discovered in a male victim of the AD 79 eruption in Herculaneum. We show exceptionally well preserved ancient neurons from different regions of the human CNS at unprecedented resolution. This tissue typically consists of organic matter, as detected using energy-dispersive X-ray spectroscopy. By means of a self-developed neural image processing network, we also show specific details of the neuronal nanomorphology, like the typical myelin periodicity evidenced in the brain axons. The perfect state of preservation of these structures is due to the unique process of vitrification which occurred at Herculaneum. The discovery of proteins whose genes are expressed in the different region of the human adult brain further agree with the neuronal origin of the unusual archaeological find. The conversion of human tissue into glass is the result of sudden exposure to scorching volcanic ash and the concomitant rapid drop in temperature. The eruptive-induced process of natural vitrification, locking the cellular structure of the CNS, allowed us to study possibly the best known example in archaeology of extraordinarily well-preserved human neuronal tissue from the brain and spinal cord.

I cibi, i luoghi e le occasioni del loro consumo sono dunque mezzi, spazi e tempi elettivi della mediazione tra immanenza e trascendenza, tra al di qua e aldilà, e, al contempo, momenti elettivi di ricreazione e affermazione di un corpo sociale; e in verità non può esservi dialogo tra immanenza e trascendenza e le entità che le popolano senza che il cibo e il suo consumo ritualizzato non ne siano parte costitutiva. Su tali condivise consapevolezze antropologiche, che hanno trovato all’interno di ogni cultura una specifica articolazione legata: a specifiche condizioni ambientali che certo hanno condizionato i regimi alimentari; a peculiari sfide identitarie che hanno portato a scelte alimentari non funzionali ai contesti di vita (ma non per questo, alimentandosi l’uomo anche di simboli, meno necessarie alla sopravvivenza); alle particolari rappresentazioni del divino e dei suoi ambiti di intervento, come dimostrano i contributi a questo convegno, si è fondato per millenni il rapporto tra uomini e dèi e tra uomini ed uomini e, sia pur in certa misura e in contesti sempre più limitati, ancora oggi continua a fondarsi. The foods, places and occasions of their consumption they are therefore means, spaces and elective times of the mediation between immanence and transcendence, between al here and beyond, and, at the same time, elective moments of recreation and affirmation of a social body; is in truth there can be no dialogue between immanence and transcendence and the entities that populate them without that food and its ritualized consumption do not are a constitutive part. On these shared anthropological awareness, that they found within each culture a specific articulation linked to: specifications environmental conditions that have certainly affected diets; to peculiar identity challenges which led to non food choices functional to life contexts (but not for this, feeding on the man also of symbols, less necessary for survival); to details representations of the divine and its areas of intervention, as the contributions to this show conference, the relationship was founded for millennia between men and gods and between men and men and, albeit to some extent and in increasingly limited contexts, still today it continues to be founded.

Background Pulmonary embolism (PE) is associated to high mortality rate worldwide. However, the diagnosis of PE often results inaccurate. Many cases of PE are incorrectly diagnosed or missed and they are often associated to sudden unexpected death (SUD). In forensic practice, it is important to establish the time of thrombus formation in order to determine the precise moment of death. The autopsy remains the gold standard method for the identification of death cause allowing the determination of discrepancies between clinical and autopsy diagnoses. The aim of our study was to verify the morphological and histological criteria of fatal cases of PE and evaluate the dating of thrombus formation considering 5 ranges of time. Methods Pulmonary vessels sections were collected from January 2010 to December 2017. Sections of thrombus sampling were stained with hematoxylin and eosin. The content of infiltrated cells, fibroblasts and collagen fibers were scored using a semi-quantitative three-point scale of range values. Results The 30 autopsies included 19 males (63.3%) and 11 females (36.7%) with an average age of 64.5 ± 12.3 years. The time intervals were as follows: early (≤1 h), recent (> 1 h to 24 h), recent-medium (> 24 h to 48 h), medium (> 48 h to 72 h) and old (> 72 h). In the first hour, we histologically observed the presence of platelet aggregation by immunofluorescence method for factor VIII and fibrinogen. The presence of lymphocytes has been identified from recent thrombus (> 1 h to 24 h) and the fibroblast cells were peripherally located in vascular tissue between 48 and 72 h, whereas they resulted central and copious after 72 h. Conclusions After a macroscopic observation and a good sampling traditional histology, it is important to identify the time of thrombus formation. We identified histologically a range of time in the physiopathology of the thrombus (early, recent, recent-medium, medium, old), allowing to determine the dating of thrombus formation and the exact time of death. Clinical trial number NCT03887819. Trial registration The trial registry is Cliniclatrials.gov, with the unique identifying number NCT03887819. The date of registration was 03/23/2019 and it was “Retrospectively registered”.

Hair, larvae and cardiac muscle, the only biological samples present on a skeletonized human body found in a rural area, were used for forensic toxicological analyses in order to determine possible causes of death. Since no information about the victim or the circumstances of death was available (except for the place where the corpse was found, known to be a gathering place for drug addicts), the first approach for the analysis of non-conventional matrices involved the screening of different classes of active principles, using a chemiluminescence-based screening assay designed for whole blood. The immunoassay test results showed positivity to amphetamines, cocaine and opiates on water/methanol extract from cardiac tissue, larvae and hair samples. Gas chromatography-mass spectrometry (GC/MS) analyses confirmed the immunoassay results, except for amphetamines. The minimal sample preparation (hydration and extraction in an ultrasonic bath), the reduced sample volume required for the analyses, together with the correctness of results as confirmed by GC/MS, showed the suitability of the screening test for forensic applications on non-conventional matrices. Quantitative analyses in GC/MS allowed the cause of death to be ascertained on the basis of the ratio between parent drugs and metabolites.

This paper takes into consideration the interconnections between, food, sexuality and spirituality which constitute the core of Michèle Roberts's novel Impossible Saints. We shall be focusing on the process of cannibalization of women's bodies, considering the term both in a metaphorical and in a literal sense with relation to the stories told in the novel. We shall examine the relationship between Roberts's "new" saints and food and the desecratory, macabre representations that the author offers of the sacred meal.

Peripartum cardiomyopathy (PPCM), a rare and potentially fatal disease, occurs in young, previously healthy pregnant women in the last stages of pregnancy and up to 5-6 months after delivery. Since its etiology is multifactorial, diagnosis is generally made via exclusion of all other causes. We here describe three cases of three young women who died suddenly and unexpectedly after giving birth by Cesarean section (C-section). These cases were brought to our attention after malpractice claims had been brought against the hospitals’ health professionals. In all three reported cases, the cardiac function suddenly and unexpectedly worsened within a few hours after C-section. Strikingly, all three women had unremarkable clinical histories. Prior to postpartum complications, they had experienced uncomplicated gestation and had given birth to healthy full-term newborns. Therefore, since in none of these cases could the women’s uneventful clinical history have foreshadowed exitus, the hospital physicians attributed their deaths to sudden cardiac arrest. The macroscopic and microscopic histological findings ruled out any other condition that might have led to the women’s sudden and unexpected deaths; the toxicological test results were all negative and no surgical anomalies were found. After painstakingly analyzing the medical and clinical data reported in the women’s medical charts, together with the histological data emerging after autopsy, in agreement with the literature, we concluded that all three women had died of peripartum cardiomyopathy. Lastly, our three cases suggest that among the various forensic methods used to determine the causes of death, the histological approach remains the gold standard for identifying the causes of death especially in previously healthy individuals who die suddenly and unexpectedly.

Especially in oncology and in critical care, the provision of medical care can require therapeutic choices that could go beyond the patient’s will or intentions of the protection of his health, with the possible adoption of medical behaviors interpreted as unreasonable obstinacy or, at the opposite extreme, as euthanasia. In some cases, the demand for obstinate therapeutic services could come from the patient or from his relatives, in which case the dilemma arises for the health professional between rejecting such a request, in respect of their professional autonomy, or abiding by it for fear of a professional care responsibility for therapeutic abandonment. We analyzed and commented on emblematic clinical cases brought to court for alleged wrong medical conduct due to breach of the prohibition of unreasonable obstinacy. In healthcare it is impossible to fix a general rule defining any therapeutic act as appropriate, because on one hand there are technical assessments of medical competence, and on the other the perception of the patient and of his family members of the usefulness of the health care provided, which may be in contrast. The medical act cannot make treatments that are inappropriate for the needs of care or even be unreasonable; conversely, before the request by the patient or by his family members for disproportionate health services in relation to the results they may give in practice, in compliance with the legislative and deontological provisions, the doctor can refuse them, thus safeguarding both his decision-making autonomy and, therefore, his professional dignity. Significance for public healthThe aim of our research is to contribute to identify the technical parameters and the ethical and deontological aspects useful to qualify a treatment as obstinate, to ensure on the one hand a treatment process that does not exceed the patient's requests or expectations (especially if unexpressed), and on the other hand to protect health workers from charges of professional liability for overtreatment damages, while avoiding attitudes of defensive medicine. Reference to the current code of Italian medical deontology is helpful in making therapeutic choices. It recommends the physician not to undertake diagnostic procedures and therapeutic interventions that are clinically inappropriate and ethically disproportionate and against the current laws, according to which the patient cannot demand healthcare treatments contrary to the law, deontology and good clinical-care practices.

The increase in the number of people who choose to have medical procedures done to improve their appearance may be due to changed social and cultural factors in modern society, as well to the ease of access and affordable costs of these cosmetic treatments. Today, two elements legitimate recourse to this type of treatment: the broad definition of health accepted by the law and the scientific community, and the provision of meticulous information to the entitled party previous to obtaining his or her consent. In Italy, while current case-law views treatments exclusively for cosmetic purposes as unnecessary, if not even superfluous, it nonetheless demands that providers inform clients about the actual improvement that can be expected, as well as the risks of worsening their current esthetic conditions.

Finding traumatic lesions on ancient skeletal remains offers a unique opportunity to investigate the circumstances surrounding the time of death. Here we present the unique find of a late 17th, early 18th century young male from Southern Italy with eight traumatic skull lesions. A detailed anthropological examination using X-ray and 3D CT scanning techniques was conducted in order to evaluate traumatic extent, direction and degree of severity of each skull injury. The nature, number and timing of repair of the traumata suggest that they were intentional blows inflicted in battle. Gross and radiographic evidence shows that the individual survived long after one of these traumata, most likely suffered in a previous battle. Shape, size and location, as well as different orientation and implied trajectory of the multiple wounds, suggest that they were produced by a heavy, sharp cutting weapon. The perimortem aspect of most of the traumata revealed them to be contemporary injuries, suffered in a final assault by a heavy sword during a face-to-face combat. The largest and deepest fracture penetrating the skull cavity possibly resulting in traumatic brain injury was here suggested as the fatal one, even if the victim may have survived for several days prior to death.

Dental treatments, as well as simple anatomical and functional repair work, can also be for aesthetic purposes. This is because the anatomical area concerned, i.e. the oral cavity, has a great power of attraction. Aesthetic treatments in general – in particular dental treatments – have been on the rise in recent years, and this has also meant an increase in claims due to patient dissatisfaction with the results obtained. Numerous laws have been introduced that emphasise the need for comprehensive prior information in order to acquire valid consent. This has resulted in the elimination of the distinction between the obligation of means and obligation of result, with achievement of the normally expected result required in any case.

the choreutical movements of the statues of saints are still today a constitutive and qualifying component of the ritual process of numerous Sicilian religious festivals, in particular those of Easter and the spring-summer ones of the patron saints. The races and dances of the Risen Christ and of the saints are generally accompanied by competitions, struggles, displays of virile attitudes, erotic allusions, the display of gold and evergreen fronds, the consumption of peculiar foods and desserts or a set of ritual symbols of an orgiastic nature which, in referring to an experience of the agro-pastoral world, appear as originally intended to celebrate and promote, at critical moments, the cosmic rebirth and fecundity, to stimulate the growth of plants, to support human fertility and animal, to re-establish the community by reaffirming its partitions and constitutive principles, to exhibit the characters of specific age groups; as emblems, together, of passing season and social status.

Nel contributo si offre una sintesi del costume funerario italico dell'entroterra pestano.